Identify whether pain is likely neuroplastic

Before practicing somatic tracking, determine whether the pain fits the profile of brain-generated rather than structural pain.

Why it works

Somatic tracking works specifically for neuroplastic pain — pain generated by a sensitized nervous system that has learned to alarm rather than by active tissue damage or a structural condition requiring medical treatment. Applying tracking to structural pain (herniated disc with active nerve compression, inflammatory arthritis) is not appropriate and could delay necessary care. Identifying the likely source of pain is a precondition for safe practice.

How to do it

1. Check: has the pain been medically evaluated and cleared of structural cause? If not, start there.
2. Look for neuroplastic indicators: pain that moves or changes, spreads symmetrically, flares with stress or emotion, persists despite normal imaging.
3. Note whether the pain began during or after a period of psychological stress, not only physical injury.
4. If uncertain, discuss with a clinician familiar with pain neuroscience before proceeding.

Evidence

The neuroplastic pain model is consistent with neuroimaging research showing altered central nervous system processing in chronic pain; the BOULDER RCT specifically selected participants with chronic back pain and normal or minimal structural findings. Hashmi et al. (2013) provided direct neuroimaging evidence that as back pain chronifies, its brain representation shifts from nociceptive to emotional circuits — grounding the case for assessing whether pain is neuroplastic before tracking. (rct)

The BOULDER trial targeted a specific chronic back pain population; generalization to other pain types should be made cautiously and with medical input.

Sources

• Ashar et al. (2022), BOULDER trial — PRT vs placebo and usual care for chronic back pain, JAMA Psychiatry
• Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, Carlisle J, Polisky L, Geuter S, Flood TF, Kragel PA, Dimidjian S, Lumley MA, Wager TD. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.
• Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023;6(9):e2333846.
• Hashmi JA, Baliki MN, Huang L, Baria AT, Torbey S, Hermann KM, Schnitzer TJ, Apkarian AV. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013;136(9):2751-2768.

Common mistake

Applying somatic tracking to pain that has an active structural cause without medical evaluation, which can delay appropriate care. Neuroplastic indicators are useful but not diagnostic — medical clearance matters.